Safety and Efficacy of Office-Based Surgery with Monitored Anesthesia Care/Sedation in 4778 Consecutive Plastic Surgery Procedures

Abstract

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.

Monitored anaesthesia care (MAC)

“…Procedures that once required patients to stay overnight in the hospital are now performed safely in office and outpatient surgical suites. 5 The introduction of new anesthetic applications enables patients to undergo lengthy and complex procedures as outpatients and then promptly and safely be discharged home. 6 The choice and route of anesthesia administration is paramount to the patient's overall surgical experience.…”

Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

“…There are many reports of the safe administration of these sedations, even with drugs not specifically approved for this indication, such as propofol [40,41]. However, the majority of the morbidity and mortality related to sedation practice is the result of respiratory compromise.…”

Office-based anesthesia

“…The author later published findings of a followup study in 2008 41 documenting results that were consistent with the previous findings. Bitar 42 specifically evaluated the adverse events rates of sedation in the office by means of a chart review of 4,778 plastic surgery procedures over a one-year period (1999)(2000). There were no deaths, ventilator requirements, or DVTs/pulmonary emboli.…”